Supporting the fight to control Ebola

Delegates from MRSA Action UK attended the GovToday conference on Reducing Healthcare Associated Infections – The Worldwide Effort this week in London.  The conference was well attended and the sessions on Ebola brought home the reality that healthcare workers are facing in the fight to bring the Ebola outbreak under control. Great efforts are being made and Arco spoke to delegates about their involvement in the supply of protective equipment and the UK’s response in terms of preparedness.

Arco provided the personal protective equipment in the first 62-bed clinic at the start of the Ebola crisis in Sierra Leone, the Ministry of Defense and Save the Children were using suits and products supplied by them.

In September 2014 the first batch of products were sent to York where training took place on how to don and doff the personal protective equipment. Temperature and humidity were replicated in a hangar.

The equipment was shipped out to Sierra Leone. The Department of Health has since expressed interest in supplying the equipment around the UK to protect healthcare workers and the National Ambulance Resilience Unit. Arco supports the Department of Health and are working with the NHS supply chain to support any cases in the UK.

For its staff the NHS specifies a coverall providing protection from spray contamination. Seams are taped. Suits keep moisture out but are breathable to avoid heat stress. Another design uses ultrasonic welds for seams. Over-boots have anti-slip soles. Single use suits are also available. All the clothing has been used in industry and two designs have air conditioning built in for heat stress. A visor is designed to avoid touching the face when removing the protective clothing, and type P3 respirators are provided. Any masks or goggles must be anti-mist but not vented. Training on the appropriate use of the equipment and buddying is essential.

There may be an aerosol risk making P3 respirators and eye protection essential.

Dr. David Sanders, a top Ebola virologist and Purdue University professor of biological science appeared on Fox News on Monday to discuss his research suggesting Ebola can be an airborne virus. “We have to consider the possibility”

“Our own research shows that Ebola Zaire enters human lung cells from the airway side. So it has the inherent capacity to enter the lung from the airway,” he said.

“I’m not saying that there’s any evidence that the current spread is due to anything but bodily fluid contact, but we have to consider the possibility that it can enter through an airway route.”

The USAMRID handbook recommends that for all VHF patients with significant cough, hemorrhaging or diarrhea, the hospital room should be a “negative-pressure isolation room” with six to 12 air exchanges, adequate to pump air out of the hospital room on a constant basis through bio-filters.

To make the point about airborne transmission of VHF viruses, including Ebola, USAMRID says all persons entering the patient’s room should wear double gloves, impermeable gowns with leg and shoe coverings for contact isolation, eye protection and HEPA (N-95) masks or positive-pressure air-purifying respirators (PARRS).

Prior to their use for treating Ebola victims the suits supplied by Arco have been used in the pharmaceutical industry where controls are strict. They are also used in chemical responses and cleaning, permeation has been well tested.

Delegates asked if industry had statistics on this type of PPE usage and any adverse events, we were dealing with the human factor where mistakes can happen. I work in the nuclear industry and our coveralls have clips at the back for removing the head gear to avoid touching the face. There is always a buddy system in operation to avoid making mistakes – especially if you are tired, this was critical as one mistake can be fatal.

Arco had a guidance document and videos on donning and doffing, but the guidance needed adapting for the situation. Medecins Sans Frontieres, the World Health Organisation and the Department of Health had not produced any specific guidance on its use for the Ebola outbreak.

Arco had experienced a degree of panic buying equipment and had set up a helpline. There had been a lack of knowledge on what’s approved and where to source the equipment. Arco approached the Department of Health who was now coordinating the sharing of resources throughout the UK. Their stock went to Sierra Leone in September and supplies were now being manufactured to the specifications requested by the NHS, Medecins Sans Frontieres, Ministry of Defense and Save the Children.

Questions were asked on the appropriateness of the equipment that had been specified by Medecins Sans Frontieres for the Ministry of Defense and Save the Children. They had been supplied with surgical masks and goggles but it was unclear whether P3 respirators were being issued as standard wear. The hoods with built in surgical masks had instructions on how to don and doff, but delegates who work in this field said that within 20 minutes without respirators the humidity had the potential to cause misting and heat stress. Their advice was that as soon as moisture builds up the protection is compromised.

Arco would take back the concerns to check that the equipment is being used appropriately; pictures in the media appear to show this design with the use of respirators. There is clearly a need to agree and formalise the procedures on the equipment to use and the donning and doffing to protect healthcare workers and avoid the spread of the disease.

The closing session at the GovToday conference looked at the epidemiology of Ebola and its close relationship to the Ebola Zaire virus, which was deadly. It was unclear why it was that some people managed to survive Ebola. Survivors tended to have high white blood cell counts with T cells managing to respond to high levels of the virus in the body. It was still unclear, but ZMapp, the antidote given to Will Pooley, would probably work better in people who had genetic characteristics showing more resilience to the disease. There was still no cure and no vaccine and answers are still being sought.

Derek Butler
MRSA Action UK
Registered Charity 1115672
07762 741114